Long-term scar quality after immediate breast reconstruction: a 4-year follow-up study on incisional negative pressure wound therapy versus conventional dressing

Background Immediate breast reconstruction (IBR) is increasingly used in the surgical treatment of breast cancer, and evidence suggests that scar quality and satisfaction with reconstruction are closely linked. Research on long-term scar quality is scarce. We investigated whether incisional negative pressure wound therapy (iNPWT) improves long-term scar outcomes compared with conventional dressing. Methods We conducted a prospective follow-up of a randomized controlled trial (RCT) comparing iNPWT with conventional dressing. Differences in scar quality between the two groups, assessed with the Patient and Observer Scar Assessment Scale (POSAS 3.0) four years postoperative, were calculated. Longitudinal changes in scar quality from one to four years were evaluated, using linearly rescaled POSAS 2.0 and 3.0 scores (0–100 scale) to enable numerical comparison across versions, as well as the correlation between patient-reported scar satisfaction and satisfaction with reconstruction. Results Twenty patients were included. No significant difference in scar quality was found between iNPWT and conventional dressing at 4-year follow-up. We found a significant difference in observer-reported scar quality from one to four years with decreases in general satisfaction (-13.89 points, p < 0.001) and sum score (-6.48 points, p = 0.006) on a 0-100 scale, independent of treatment group. No difference between groups and minimal difference in patient-reported outcomes. A strong correlation between scar satisfaction and satisfaction with reconstruction was found (ρ = 0.62, p = 0.0021). Conclusion No evidence of iNPWT improving long-term scar quality following implant-based IBR compared to conventional dressing was found. Given the substantially higher cost of iNPWT and the absence of evidence regarding long-term scar benefit, its routine use for the purpose of scar optimization alone may not be justified. Scar quality continued to change beyond one year postoperatively, and scar satisfaction was strongly correlated with overall satisfaction with reconstruction, underscoring the clinical importance of long-term scar outcomes. Level of Evidence Level III, therapeutic study.